Lack of patient records leads to $14,040 Medicaid recoupment from healthcare provider
Docket Number: 2220233 , Decision Date: September 21, 2022
Attachment: Click here to download the decision.
The Department of Community Health sought to recoup $14,040.00 paid to a healthcare provider for services it delivered through Medicaid. The Court affirmed the Department’s decision, finding that the provider did not have sufficient patient-treatment records that would justify the billed Medicaid costs. Although the provider argued the COVID-19 pandemic prevented it from obtaining the necessary records, the Court rejected that reasoning, noting that it “strains credulity” to believe the provider could not contact a patient’s physician to get the necessary Plans of Treatment that would show which services were received.